The British journal of general practice : the journal of the Royal College of General Practitioners
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Multicenter Study
UK childbirth delivery options in 2001-2002: alternatives to consultant unit booking and delivery.
Government policy advocates maternal choice in pregnancy care. Two key issues are place of birth and type of lead professional. Anecdotal evidence suggests there is variation in both these issues across the UK, but there has been no recent national assessment of whether maternal options are in line with government policy. ⋯ Despite government policy promoting greater parental choice, this is not in evidence in many parts of the UK. The wide variations in home birth, midwife-led care and maternity-unit types merit further exploration. If more midwife-led units are to be established as a way of promoting parental choice and dealing with junior doctor rota problems, then such units must have adequate governance and training activities in place.
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Stress has become an increasingly common presentation in general practice. This may relate to an increase in stress in people's lives or a change in the meaning of stress and its conceptualisation as a legitimate problem for the GP. ⋯ The belief that stress-related symptoms are a legitimate problem for the GP is not universal and varies according to ethnic group. Stress is used by different patients in different ways and offers a variable pathway to the doctor.
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Increasing numbers of injecting drug users are presenting to primary care and a growing number of general practices are specifically providing care for homeless people. Injecting drug users are at the greatest risk of hepatitis C infection and homeless drug misusers, because of their drug-taking behaviour and patterns, have been identified as being at greater risk of harm of blood-borne diseases than the general population. However, little work has been conducted with injecting drug users or homeless people who have hepatitis C and little is known about how the virus may affect them. ⋯ The implications for clinical policy and primary care practice are discussed, including the issues of patient choice, confidentiality, and pre- and post-test discussions. Posttest discussions should be followed up with additional social, psychological, and medical support and counselling.
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Editorial Comment
The prevention of suicide in later life: a task for GPs?